{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:57:00Z","timestamp":1790794620047,"version":"4.1.0"},"reference-count":37,"publisher":"Canadian Society of Respiratory Therapists","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Introduction<\/jats:title>\n Pulmonary rehabilitation (PR) improves exercise capacity, functional status, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, these benefits often decline over time, necessitating repeated PR. Evidence regarding the effectiveness of repeated PR on clinical outcomes remains limited. This study evaluated the effects of a second PR program on functional, physical, and patient-reported outcomes in patients with COPD.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Data from patients with COPD who completed two PR programs (PR1 and PR2) at Ciro, Horn, the Netherlands, between January 2005 and September 2022 were retrospectively analyzed. Outcomes included exercise capacity (constant work rate test [CWRT]), quadriceps muscle strength (isokinetic quadriceps strength [IQS]), functional capacity (6-minute walk distance [6MWD]), and patient-reported outcomes using the COPD Assessment Test (CAT), St.\u00a0George\u2019s Respiratory Questionnaire (SGRQ), Hospital Anxiety and Depression Scale (HADS), and Canadian Occupational Performance Measure (COPM).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 7,984 PR records, 429 patients (858 PR records) met the inclusion criteria (54% men; mean age 62.5\u00b18.1 years; FEV\u2081 43.5% predicted). Significant improvements were observed following both PR programs, including 6MWD (PR1: Mean Difference [MD] 37.0 m, 95% Confidence Interval [CI] 29.2\u201344.8; PR2: MD 27.0 m, 95% CI 19.2\u201334.8) and IQS (PR1: MD 10.4 Nm, 95% CI 8.4\u201312.4; PR2: MD 8.6 Nm, 95% CI 6.6\u201310.6), as well as for CWRT, CAT, SGRQ, HADS, and COPM (all\n p<\/jats:italic>\n < 0.05). Improvements in 6MWD and IQS were significantly greater after PR1 than PR2 (\n p<\/jats:italic>\n < 0.05). All outcomes declined significantly between completion of PR1 and initiation of PR2 (\n p<\/jats:italic>\n < 0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Discussion<\/jats:title>\n Although improvements following repeated PR were smaller than those after the initial program, clinically meaningful gains were achieved across multiple outcomes, supporting the value of repeated PR in patients whose health status deteriorates over time.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Repeated PR effectively improves functional capacity, muscle strength, exercise performance, and patient-reported outcomes in patients with COPD. Strategies to sustain PR benefits after program completion should be prioritized.<\/jats:p>\n <\/jats:sec>","DOI":"10.29390\/001c.169555","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:23:11Z","timestamp":1790792591000},"source":"Crossref","is-referenced-by-count":0,"title":["Effectiveness of repeated pulmonary rehabilitation in patients with chronic obstructive pulmonary disease"],"prefix":"10.29390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7466-7973","authenticated-orcid":true,"given":"Jibril","family":"Mohammed","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/049pzty39","id-type":"ROR","asserted-by":"publisher"}],"name":"Bayero University Kano","department":["Department of Physiotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Houben-Wilke","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03b8ydc26","id-type":"ROR","asserted-by":"publisher"}],"name":"Ciro","department":["Department of Research and Development"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam T.J.","family":"Groenen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03b8ydc26","id-type":"ROR","asserted-by":"publisher"}],"name":"Ciro","department":["Department of Research and Development"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits M.E.","family":"Franssen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03b8ydc26","id-type":"ROR","asserted-by":"publisher"}],"name":"Ciro","department":["Department of Research and Development"]},{"id":[{"id":"https:\/\/ror.org\/02d9ce178","id-type":"ROR","asserted-by":"publisher"}],"name":"Maastricht University Medical Centre","department":["Department of Respiratory Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rein","family":"Posthuma","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03b8ydc26","id-type":"ROR","asserted-by":"publisher"}],"name":"Ciro","department":["Department of Research and Development"]},{"id":[{"id":"https:\/\/ror.org\/02d9ce178","id-type":"ROR","asserted-by":"publisher"}],"name":"Maastricht University Medical Centre","department":["Department of Respiratory Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daisy J.A.","family":"Janssen","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03b8ydc26","id-type":"ROR","asserted-by":"publisher"}],"name":"Ciro","department":["Department of Research and Development"]},{"id":[{"id":"https:\/\/ror.org\/02jz4aj89","id-type":"ROR","asserted-by":"publisher"}],"name":"Maastricht University","department":["Department of Health Services Research and Department of Family Medicine"]},{"id":[{"id":"https:\/\/ror.org\/035thvx71","id-type":"ROR","asserted-by":"publisher"}],"name":"Proteion","department":["Department of Expertise and Treatment"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martijn A.","family":"Spruit","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03b8ydc26","id-type":"ROR","asserted-by":"publisher"}],"name":"Ciro","department":["Department of Research and Development"]},{"id":[{"id":"https:\/\/ror.org\/02d9ce178","id-type":"ROR","asserted-by":"publisher"}],"name":"Maastricht University Medical Centre","department":["Department of Respiratory Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anouk W.","family":"Vaes","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03b8ydc26","id-type":"ROR","asserted-by":"publisher"}],"name":"Ciro","department":["Department of Research and Development"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"11956","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"ref1","article-title":"2026 GOLD Report and Pocket Guide","journal-title":"Global Initiative for Chronic Obstructive Lung Disease - GOLD"},{"issue":"1","key":"ref2","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1038\/s41533-018-0085-7","article-title":"Facilitators and barriers to physical activity following pulmonary rehabilitation in COPD: a systematic review of qualitative studies","volume":"28","author":"H. 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